LIVE @Diabetes Care: Patient-Centered 2015 Conference, Boston 4/16-4/17, 2015
Reporter: Aviva Lev-Ari, PhD, RN
LIVE from the podium
#AJCLive
@AJMC
Dr. Lev-Ari in attendance at the Renaissance Waterfront Hotel in Boston, REAL TIME PRESS COVERAGE
First Lecture
Patrick J O’Connor, MD,MA,MPH
The Patient’s Toolbox for Better Decision Making
- Different Numeracy and Health Literacy, language and culture -Navaho Tribe no ceremony for Diabetes in the Past, obesety in the Present
- Prioritize Treatment Otions
- BP=1, Lipids=3, Smoking=4, Glucose=1, BMI=2, not on aspirin=2
- comorbidities, study in Sweden, 47 died of CVD and Stroke, only one from complications of Diabetes
- Patient education
7.5% in ten years ASCVD Risk for every 1000 people taking moderate-intensity of STATIN FOR 10 years:
26 will have a heart attack despite of Statin
if aspirin
9 would avoid an MI
65 will have an MI despite aspirin
Treatment for Diabetes Diagnosis given to Patient – MD’s Strategies
– explanatory Model applied
– readiness to change
– conversation experience
– try to be the patient, when conditions changes
Patient-Centered Care
– Listen to the patient, carefully, when you say start Insulin, what does the Patient hear???
Second Lecture
Dr. Silvio Inzucchi, MD – Yale University, Endocrinologist
Personalizing Diabetes Care: Matching Patients and Therapies
Strategies in Diabetes Clinics – management of 12 drug classes to treat Hyperglicemia
PERSONALIZING DIABETES CARE – Modulation of the Intensiveness of glucose lowering therapies in T2DM
1. Caliration of Treatment Targets
2. Hypoglicemia
potentially modifiable:
A. Patient Attitude
B. Resources and support system
SELECTION OF TREATMENT OPTIONS
Metformin – Monotherapy: Healthy eating, weight control, increased physical activity, diabetes education
—->>>>>>>>. DUAL THERAPY: Metformin plus one of the below options
TZDs – increase weight
—->>>>>>>>. TRIPLE THERAPY: Metformin plus two drugs
DPP-4 Inhibitors expensive
SGLT2 Inhibitors expensive
GLP-1-R agonist expensive
Insulin risk of causing Hypoglacemia cost varies
IF HYPERGLICEMIAPERSONALIZING REMAINS UBCONTROLLED THAN
Metformin plus Insulin at meal time plus one additional drug
INTENSIVE THERAPY: Basal Insulin, Add Rapid Acting, add long acting <<<<<<< —–
1. pathophysiology:
– insulin Resistence, Insulin deficiency
– FPG VS PPG
– Latent Autoimmune
– Rare monogenic
2. Precaution
3. perks, BP
4. Practicalities: Labs, poly pharmacy
COST OF TREATMENTS in 30 days
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